Decision-making of hemorrhagic shock patients with intraperitoneal bleeding (IPB) by ultrasonography (US): the importance of early detection of an increase of IPB

Background and objective

Hemorrhagic shock patients with abdominal trauma require immediate decision-making of treatment; laparotomy or not. If IPB is massive, we have to do a laparotomy; and if it is little or not increasing, we need not. Emergency transcatheter arterial embolization (E-TAE) is a more common therapeutic procedure in Japan, compared with in European countries. E-TAE contributes towards the avoidance of unnecessary laparotomy. However, a patient who underwent E-TAE is fully covered and we cannot watch the abdomen of the patient. We can evaluate the patient's condition only by heart rate and blood pressure, often resulting in a lethal delay in decision-making. Recently we evaluated the increase of IPB during E-TAE by portable US (PUS), which is usually used for bedside examination or out-of-hospital evaluation. The aim of this study is to clarify the usefulness of PUS for decision-making during E-TAE and safety of E-TAE under monitoring by portable US.

Materials and methods

In our center, the angiography room is situated close to the emergency room, on the same floor. We can transfer the patient between these rooms within 5 min. In our protocol for blunt abdominal trauma, shock patients with abundant IPB should be brought to the operation room, and nonshock patients should be treated with TAE or only rest. We evaluate the increase of IPB in 26 cases by PUS during E-TAE in the narrow space, where we cannot use ordinal US.

Results

Before TAE, IPB was detected in 15 cases and pelvic or lumber fracture was detected in 14 cases and renal injury or massive retroperitoneal hematoma in five cases. The mean duration of TAE was 106 min. An increase of IPB was detected in three cases; one of whom was examined and treated for hepatic and splenic arteries at first and ileac arteries later, and another patient was transfered to the operation room immediately. In other 23 cases, we confirmed no increment of IPB by PUS and could continue the procedure without fear of preventable death.

Conclusion

E-TAE is a safe procedure under monitoring of IPB by PUS, which can detect the increase of IPB during E-TAE.